PLACER AQUATICS CLUB
WINTER AQUATICS CLINICS
2016-2017 Season
GRANITE BAY HIGH SCHOOL
PAC will be offering several winter clinics to meet athlete’s different training needs. Competitive swimming or
water polo experience is not necessary, but athletes must have a minimum skill level determined by group. The
goal of these clinics is to offer athletes of all abilities the opportunity to improve in all aspects of their sports.
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PAC High School Swim Clinic
November 28 – February 3
This training program is open to any high school swimmers. This program is designed to prepare swimmer
for the upcoming high school swim season. The primary focus of this clinic is to improve strength,
technical skills, and increase aerobic threshold through workout.
Coaches Sherman, Reego, Meeker,
HS Girls and Boys
MW 4:30-6 & TThF 3-4:30
$350
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PAC / Gators Swim Clinic
November 28 – February 10
This clinic is open to any swimmers over the age of 6. This clinic is designed to prepare swimmers for the
upcoming rec season by improving technique and skills as age appropriate.
Coaches Meeker and Chavez
8-14 Girls and Boys MW 6-7 & TTh 6:45-7:45
$300
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Boys Winter Water Polo & Swimming
November 28 – February 17
The most comprehensive boys winter aquatics program in the area. This 11-week season is designed for
high school varsity and junior varsity level players, includes tournaments and concludes with Winterfest.
Players will learn and develop skills and strategies necessary for both personal improvement and advanced
team play. Players are expected to play in tournaments with the team. All players must be registered with
USA Water Polo (online registration @ www.usawaterpolo.com) and swim in the PAC Winter Clinic.
Coaches Reego, MacLeane, Lawrence
Boys Polo Combo
MW 3-4:30 & TThF 4:15-6:45
$800
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Girls Winter Water Polo & Swimming
November 28 – February 17
The most comprehensive girls winter aquatics program in the area. This 11-week season is designed for
high school varsity and junior varsity level players, includes scrimmages on T/Th and concludes with
Winterfest. Players will learn and develop appropriate skills and strategies necessary for both personal
improvement and advanced team play. Players are expected to play in tournaments with the team. All
players must be registered with USA Water Polo (online registration @ www.usawaterpolo.com).
Coaches Saldana, Saldana
Girls Polo Combo
MW 7-8:30 & T/ Th TBA
$650
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ALL REGISTRATION MUST BE COMPLETED ONLINE @ www.GraniteBayGators.com
SWIMMING
BOYS WATER POLO
GIRLS WATER POLO
John Sherman
Andrew Reego
Mike & Jeannette Saldana
[email protected]
[email protected]
[email protected]
Placer
Aquatics
Club
PAC Swimming and Water Polo Registration
Winter 2016-2017
Family Information
Parent/Guardian
Last Name_______________________________First (Dad)____________________________First (Mom)____________________________
Street Address_________________________________________________________City and Zip___________________________________
Phone H_____________________________Phone W________________________________Phone C________________________________
We do all of our communication via email. Please include your EMAIL ADDRESS______________________________________________
PAC Winter Swimming
A) High School Swimming
B) Gators Youth Swimming
$350
$300
Granite Bay Water Polo
C) Boys Water Polo & Swimming Combo
D) Girls Water Polo & Swimming Combo
$800
$650
First
MI
Last
Group (A-E)
Sex
Birthdate
Fee
_____________________ _____ __________________________ _______________ M / F
___________________ ________
_____________________ _____ __________________________ _______________ M / F
___________________ ________
_____________________ _____ __________________________ _______________ M / F
___________________ ________
_____________________ _____ __________________________ _______________ M / F
___________________ ________
*Please list athletes USA Water Polo #’s and Exp Date below.
Total Registration Fee
To complete registration, please submit the following 3 necessary items to
1-Registration Form
2-Waiver and Release
3-Registration Fee
PAC Registrar
4340 Sandhurst Ct
Rocklin, Ca. 95677
[email protected]
Placer
Aquatics
Club
EMERGENCY MEDICAL INFORMATION
Swimmer’s name: ___________________________________________Present age: _____________ Date of birth: _____\_____\_____ Sex: M \ F
Fathers/Guardian:_____________________________Home: __________________ Work: ____________________Cell______________________
Mother/Guardian: _____________________________Home:___________________Work: ____________________Cell______________________
In the event of an emergency and parents/guardians cannot be reached, call
Name: _____________________________________ Phone #: ______________________Relationship: __________________________________
Name: _____________________________________ Phone #: ______________________Relationship: __________________________________
In the event of an accident or other emergency, I hereby authorize a representative of PAC to make such arrangements, as he/she considers
necessary for my child to receive medical or hospital care, including necessary transportation under such circumstances. I further authorize the
physician named below or any licensed physician or surgeon to undertake such care and treatment of my child, as he/she considers necessary.
Insurance Carrier_________________________________________________Medical Number_________________________________________
Physician Name__________________________________________________Phone Number__________________________________________
The undersigned hereby agrees to bear all costs incurred as a result of the foregoing, and this authorization will remain in effect until revoked by
X_______________________________________ _______________ X__________________________________________ _______________
Mother/Guardian Signature
Date
Father/Guardian Signature
Date
Does your child have any allergies of which we should be aware? (circle) yes / no
If yes, please list and explain,______________________________________________________________________________________________
Does your child have any previous injuries, handicaps, disabilities, illness, or disease of which we should be aware? (circle) yes / no
If yes, please list and explain,______________________________________________________________________________________________
Does your child currently take and medication? (circle) yes / no
If yes, please list and explain,______________________________________________________________________________________________
Please note, in the following area, any known medical/health problems of which PAC, or any of its agents, should be aware.
______________________________________________________________________________________________________________________
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LIABILITY AND WAIVER STATEMENTS
Participants Name________________________________________________________
Please read carefully before signing. This is a release of liability and waiver of certain legal rights
.
LIABILITY STATEMENT
Parents or guardians of Placer Aquatics Club athletes are liable for any damage to property or injury to individuals caused by their athletes at the
Granite Bay High School or at any facility or venue the Placer Aquatics Club visits in any capacity.
WAIVER STATEMENT
I, ____________________________________, the parent/guardian of the enrolled participant agree and understand that swimming / water polo is a
HAZARDOUS activity. I recognize that there are risks inherent in the sports of swimming / water polo, including but not limited to, paralyzing injuries
and death. The participant hereby agrees to participate in a Placer Aquatics Club program, and hereby agrees to indemnify and hold harmless the
Placer Aquatics Club, its programs, coaches, officers, directors, agents and employees against any liability resulting from any injury that may occur
to the participant while participating in any Placer Aquatics Club program activity. The participant also agrees to indemnify Placer Aquatics Club for
any claims, demand action or cause of action by the participant. The participant authorizes any representative of Placer Aquatics Club to have the
participant treated in any medical emergency during their participation in a Placer Aquatics Club program activity. Further, the participant and/or
parent/guardian agree to pay all costs associated with medical care and transportation for the participant.
I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGN IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE .
Signed: _________________________________ Date: __________________ Phone:_____________________Phone_____________________
Parent/Guardian